Heres everything you need to know about it. To cancel or waive your coverage, visit the PEBB Program website using these links: Uniform Medical Plan (UMP) is a self-insured Preferred Provider Organization (PPO) medical plan offered through the Washington State Health Care Authority. 0000009222 00000 n When dependent children are double-covered by divorced parents, coverage depends on any court decrees. BCBS Federal Phone Number; Ambetter Claims address and Phone Number; Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit; Kaiser Permanente Phone Number . Mailing address: Blue Cross of Idaho. Regence Blue Shield of Idaho - FEPPO Box 30270Salt Lake City, UT 84131-0207. To help you move from paper to electronic claims, follow these steps: Electronic claims can be sent when we are the secondary insurance payer. 0000008298 00000 n If we do not receive a response within the specified period, the claim(s) is denied pending further information. AHK Anthem Blue Cross of California We also apply the following Prompt Pay standards set by the Oregon Insurance Division to our claims adjudication process in order to: A clean claim is one that has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstances requiring special treatment that prevents timely payments from being made on the claim. Lewiston, ID 83501 . CVK BCBS of Florida Both for dental and medical professional services, promises forms can be found. Members and Providers: 1-800-395-1616 Email Us. 6:00 AM - 5:00 PM ASTFax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals only)Fax: 866-948-8823 (FEP Care Dont write or stamp extra information on the form. contracted): If we fail to satisfy any of the above standards, commencing on the 31st day, well pay interest at a 15 percent annual rate on the unpaid or un-denied clean claim. Prompt Pay interest is currently calculated monthly for the previous month's paid claims. Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. AAC BCBS of IL Availity supports the exchange of electronic remittance advice (ERA) files for Regence payers in the ASC X12 835 format. ACN BCBS of IL While you pay for coverage through UW, the state designs the plans and contracts with Regence BlueShield and Washington State Rx Services to administer the plan. Related . ADC BCBS of IL Pay clean claims within 30 days of receipt; and, Pay unclean claims within 15 days after receipt of information, Pay unclean claims within 30 days after receipt of information. DCL BCBS of TN We can process the claim after we receive that information. Completion of the credentialing process takes 30-60 days. Human Resources Inquiries. https://drive.google.com/file/d/0Bzbk78qiF4H_ZU9NTmxSenJwb0U/view?usp=sharing, Nice to know, this should be useful as a reference, I'm just looking for the alpha prefix reference list for OHIO but all I keep getting is other states. Policy #s: Regular 10017241-0001, Transit 10017241-0004, Sheriff 10017241-0016 . A required waiting period must pass before we can provide benefits for this service. Blue-Cross Blue-Shield of Illinois. 0000018383 00000 n Prescriptions. You will need special software to send insurance claims electronically. Box 1106Lewiston, ID 83501-1106Fax: 1 (877) 357-3418 If you have questions about submitting a claim for services outside the U.S., call UMP Customer Service. For general inquiries and questions about the Service Benefit Plan, our overseas and pharmacy coverage or fraud assistance, you can call us toll-free nationwide. They have Coordination of Benefits when we are the secondary carrier on the claim. That's why Anthem uses Availity, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to healthcare professionals. ), Charges billed by physician/provider at a line item level, Amount allowed for service at a line item level, Adjudication explanation code(s) at a line item level and claim level (if applicable), Printed at the end of each claim, the line items are summed and an asterisk indicates the claim total line, Less Paid to Codes Listed as S or C, The sum of the claim total Payable Amounts which have a PD TO code of S or C, The sum of any amount withheld and applied to a prior refund or recovery. Its often confused that BCBS have lot of prefixes and where to contact. Learn how to contact your local Blue Cross and Blue Shield company, as well as other key areas. Select the area of the map that matches the color of the county where the service was performed. Generally, if the court decrees financial responsibility for the child's healthcare to one parent, that parent's health plan always pays first. CZE Anthem Blue Cross of California UMP medical plans are administered by Regence BlueShield. Congestive Heart Failure. Visit the Regence provider website, regence.com to learn more about: Claims and payment: Appeals. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. Eastern WA and Alaska providers submit to Premera. If it is, call the BlueCard Eligibility line 800-676-BLUE (2583) to verify the ID number. treatment center. We send the member a questionnaire requesting information to determine if benefits are available. It is important to file a claim with all insurance companies to which the member subscribes. There is a balance due to us at the end of the payment cycle. 598 0 obj <>stream When members of Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. ABA BCBS of IL EMPIRE BCBS Decides the pre certification requirements based on the prefix id. you will need to contact Regence to update your account to ensure your claim processes correctly and timely. AAX Anthem Blue Cross of California Federal Employee Program Overseas Claims P.O. Every user of BCBS health insurance is assigned an alpha prefix that contains three letters. Management - prior auth/pre-service requests), Members: Log in or register - MyBlue Customer eService, Retail Pharmacy Program PO Box 52057 Phoenix, AZ 85072, Retail Pharmacy Program PO Box 52080 Phoenix, AZ 85072, Phone:800-552-0733Fax: 801-333-6523 (Mark claims: Attn New Claims)Email: Log in or register - MyBlue Customer eService, Regence BlueShield - FEPPO Box 857Lewiston, ID 83501, Regence BlueShield - FEPPO Box 1388Lewiston, ID 83501Customer Service. Please request a current ID card from the member. View the instructions for verifying your information and notifying us of changes. If the information received indicates an on-the-job illness or injury, both the member and physician/provider will receive a denial that states the Premera contract excludes work-related conditions. AGR Anthem BCBS of Colorado Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately). Policy #s: Regular10017241-0001, Transit10017241-0004, Sheriff10017241-0016, Chinook Building All services rendered by the same provider for the same patient for the same date of service must be submitted on one claim form. Note : We have added some more prefixes in the list. 0 All other related costs incurred by the parties shall be the responsibility of whoever incurred the cost. 0000128769 00000 n ADT BCBS Minnesota DJY Anthem BCBS of Ohio 0000000016 00000 n CVM Anthem BCBS of Ohio AHW BCBS of MA Retirees and PEBB Continuation Coverage members:Phone: 1 (800) 200-1004TRS: 711Business hours: Monday through Friday 8 a.m. to 4:30 p.m. (Pacific). The mediator consults with the parties, determines a process, and schedules the mediation. Claims. ACQ BCBS of Georgia Claims may also be delayed during processing if: AlaskaProviders (Non-contracted and AEZ Wellmark BCBS Iowa/South Dakota The claim will be reprocessed and reflected on the payment voucher. You may like to substitute any prefix of BCBS with an existing BCBS. Claims & payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. ** Members who are part of the FEP will have the letter R in front of their member ID number. We also provide information regarding mediation should you disagree with the decision. Money was posted to your account during the payment cycle. All Rights Reserved to AMA. Oregon Providers (non-contracted and contracted): If we fail to satisfy any of the above standards, commencing on the 31st day, well pay interest at a 12 percent annual rate on the unpaid or un-denied clean claim. CVS Caremark. We will notify you once your application has been approved or if additional information is needed. Sign the completed form where indicated at the bottom of this page and submit the completed claim form to: Regence BlueShield Attn: UMP Claims PO Box 1106 Lewiston, ID 83501-1106 or by fax to: 1 (877) 357-3418 Payments will be mailed to the address on file for the subscriber. AAK Anthem Blue Cross of California Where do I determine if a code is covered? Seattle, WA 98111-9202, Back to Medical Reference Manuals overview, Espaol | We recommend that you make copies of everything that is submitted for your personal records. CYY Premera Blue Cross of Washington KingCareSMuses a preferred provider organization (PPO) for its network. For complete plan details, seeBenefits Summaries. You can reach Customer Service by calling 877-342-5258, option 2. If you already have a computer system, notify your software vendor of your desire to convert to electronic claims. Stay up to date on what's happening from Bonners Ferry to Boise. Regence BlueShieldAttn: UMP ClaimsP.O. Uprise Health General Access . complies with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation. Management - prior auth/pre-service requests), Email: Members: Log in/register at MyBlue Customer eService, Regence BlueShield - FEPPO Box 21709Seattle, WA 98111. AFO Arkanasa Access eContracting to view and sign agreement documents. AGX Anthem BCBS of Virginia When two or more health plans cover a member, COB protects against double or over-payment. When members from Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. Only a member can request a Level I or Level II Appeal for a non-billing issue, unless the member has completed a release to allow the provider to act as their Representative. AFI BCBS of Rhode Island Payment of this claim depended on our review of information from the provider. We will continue to update this section of our website to make sure you have the latest COVID-19-related information and helpful resources. 4. Be on . CVV Anthem Blue Cross of California AAB BCBS of Michigan Once the IQ is returned, all claims are reviewed and processed based on the information supplied. A member is primary on the plan in which he/she is the subscriber versus the plan in which he/she is a dependent. We use an automated processing system to adjudicate claims. Regence Uniform Medical Plan Vision Claim Form - An ERISA Section 502 (a) prepare can be reported in many different methods. If Workers' Compensation denies payment of such claims, Premera will pay according to the subscriber's contract benefits after receiving a copy of a valid denial. AEG Anthem BCBS of Ohio ABE BCBS Minnesota ), claims will be processed accordingly and under the terms of our subscriber's contract. Provider: please send us the radiology reports for this claim. Disclosure Notice Patient Protection Surprise Billing, 270/271 Eligibility inquiry and response, 278 Referral certification and authorization, 837 Claims and encounters (P, D, and I). Claims submitted that indicate possible Workers' Compensation illness or injuries are investigated. AGT Blue Shield of California Modifications we make to your contract or to our policy or procedures are not subject to the appeal process unless we made it in violation of your contract or the law. AFK Empire BCBS Church Street Station. ABL BCBS of IL ACX BCBS of IL 0000004829 00000 n We regularly update (at least quarterly) our claims editors to keep pace with changes in medical technology, as well as CPT codes, HCPCS codes, and ICD-10-CM/PCS Diagnosis and Procedure code changes, standards, and complexities. Diabetes. Designed by Elegant Themes | Powered by WordPress. Complete the enrollment form on the following page to receive 835 ERA files from Regence payers . AHD BCBS of South Carolina Alpha Prefix, The three-character alpha prefix at the beginning of the members identification number is the key element used to identify and correctly route claims. There is other activity on your account during the payment cycle. Phoenix, AZ 85072, Phone:800-562-1011 . QMD Retail ON Exchange Your member ID card is your key to using your medical plan benefits. AGY BCBS of South Carolina However, there are some exceptions. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. | For other language assistance or translation services, please call the customer service number for . ACH Wellmark BCBS Iowa/South Dakota Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. Thank you for the care you provide to our members and people in our communities. The IQ is available in the Provider Library under Forms. Note: Some members will remain in Blue Cross of Northeastern Pennsylvania health plans until their coverage renews to Highmark health plans later this year. The alpha prefix is critical for inquiries regarding the member, including eligibility and benefits, and is necessary for proper claim filing. ACS BCBS of IL Regence health plans operate in Oregon, Idaho, Utah and select counties in Washington, each an independent licensee of the Blue Cross and Blue Shield Association dedicated to making health care better, simpler and more affordable. Prefixes with * include all characters for the 3rd position unless otherwise listed, https://www.premera.com/documents/020469.pdf. You can learn more about credentialing by visiting the provider section of our website. If we processed the original claim incorrectly, you do not need to rebill. . Regence Provider Appeal Form. All Excellus plans use this mailing address: Excellus BCBS Attn: Claims P.O. Many residents in our time do not aware about how they can decide on the alpha prefix and reap more than a few benefits from the best suitable health insurance plan. View the toolkit Claims submission Pay or deny 95 percent of a provider's monthly clean claims within 30 days of receipt; and. Is distinct from our medical policy, which sets forth whether a procedure is medically necessary/appropriate, investigational or experimental and whether treatment is appropriate for the condition treated. To help your office complete year-end accounting, each December we'll issue you a check for the accrued interest we owe you, even if the amount is below the This is a claim adjustment of a previously processed claim. Box 91102 We'll notify you in writing or by telephone when you have successfully completed the test phase. The main identifier for out-of-area members is the alpha prefix. Fraud or abuse You can remain anonymous. When submitting claims, transfer the members identification (ID) number exactly as printed on the ID card. BCBS Provider Phone Number. Supplier Registration 1-800-962-2731. CVA Anthem BCBS of Ohio AIH Anthem Blue Cross of California Prefix Plan Name, AAA BCBS of Alabama YDO Retail OFF Exchange national customer service numbers at fepblue.org, Espaol | This is a duplicate of a previously denied claim. endstream endobj 554 0 obj <>/Metadata 28 0 R/Pages 27 0 R/StructTreeRoot 30 0 R/Type/Catalog/ViewerPreferences<>>> endobj 555 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 -306.0 -396.0]>>/PageUIDList<0 203>>/PageWidthList<0 612.0>>>>>>/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 556 0 obj <> endobj 557 0 obj <> endobj 558 0 obj <> endobj 559 0 obj <> endobj 560 0 obj <> endobj 561 0 obj <> endobj 562 0 obj [591 0 R] endobj 563 0 obj <>stream DKC BCBS of Texas AET Anthem Blue Cross of California Care Management Programs. AFG BCBS of Nebraska A non-billing issue is classified as a member appeal because the financial liability is that of the member, not the provider (please refer to Chapter 6). Email: Prproviderrelations@bcidaho.com. CYP BCBS of IL P | 0000007198 00000 n Blue Advantage Administrators of Box 21267 M/S S518 Seattle, WA 98111-3267 Claims appeals, balance billing or pricing disputes The process for submitting an appeal depends on your issue. You can recognize Managed Care/POS members who are enrolled in out-of-area networks through the member identification card as you do for all other BlueCard members. DJW Wellmark BCBS Iowa/South Dakota AEQ BCBS of Michigan DJE BCBS of Alabama QMC Retail OFF Exchange Note: When submitting an email inquiry, please include your tax identification number (TIN) and/or Organizational NPI number. We require that you verify the information about your practice and the networks you participate in at least every 90 days. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. The alpha prefix identifies the Blue Plan or National Account to which the member belongs. Since new ID cards may be issued to members throughout the year, this will ensure that you have the most up-to-date information in your patients file. Always refer to the online branded versions of our payment policies to ensure the most current and accurate information. Phoenix, AZ 85072, Retail Pharmacy Program ), Covered under the provisions of motor vehicle medical policy, personal injury protection (PIP), medical payments (Medpay), Uninsured (UIM) and/or underinsured (UM) motorist or other similar coverage (e.g., homeowners, commercial medical premises), Checks for eligibility of the member listed on the claim, Compares the services provided on the claim to the benefits in the subscribers contract, Applies industry standard claim edits and applicable payment policy criteria, Applies to professional and facility claims. Claim Forms; Get to know your member ID card. Costco Mail-Order PharmacyOnline: Sign in to your Costco accountPhone: 1 (800) 607-6861TRS: 711Fax: 1 (800) 633-0334Business hours: Monday through Friday: 5 a.m. to 7 p.m. (Pacific) Saturday: 9:30 a.m. to 2 p.m. (Pacific)Note: UMP members do not need to be Costco members to use their mail-order service. CVT Anthem Blue Cross of California AFY BCBS of IL AGS Anthem Blue Cross of California They will be satisfied when they properly use this insurance plan and fulfil overall requirements on the prompt assistance for claiming the insurance. CZX Anthem BCBS of Ohio Regence and other health insurers share responsibility for Blue Cross and Blue Shield Federal Employee Program (BCBS FEP) claims information, claims processing and customer service based on the location of where the services were performed and the type Find a doctorContact us Sign in AHI BCBS of Rhode Island DJM BCBS of Texas CUU BCBS of Texas You could download the full BCBS prefixes list is here. AII BCBS of Louisiana Care Management Programs. 0000014956 00000 n If you feel some of our contents are misused please mail us at medicalbilling4u at gmail dot com. Service not a benefit of subscriber's contract, Investigational or experimental procedure. PO Box 1106. Postal Prescription ServicesOnline: Your PPS accountPhone: 1 (800) 552-6694TRS: 711Fax (for providers only): 1 (800) 723-9023Business hours: Monday through Friday 6 a.m. to 6 p.m. and Saturday 9 a.m. to 2 p.m. (Pacific), Ardon HealthPhone: 1 (855) 425-4085TRS: 711Fax (for providers only): 1 (855) 425-4096Business hours: Monday through Friday 8 a.m. to 7 p.m. and Saturday 8 a.m. to 12 p.m. (Pacific), Online: Medicare or MyMedicarePhone: 1 (800) MEDICARE (1-800-633-4227)TTY: 1 (877) 486-2048. Units shown in box 24G of the CMS-1500 form. Providers. Click on the Submit a Preauthorization Request link. 0000008433 00000 n ADF Healthnow of NY Buffalo Coordination of Benefits (COB) is a provision included in both member and physician and provider contracts. Blue Cross and Blue Shield of Illinois P.O. State Lookup. Illinois. Briefly, these rules are as follows: Some group contracts are not subject to state regulations may have unique COB rules that could change the order of liability. DJJ Horizon BCBS of New Jersey 0000015026 00000 n CWB BCBS of Georgia Our medical staff reviewed this claim and determined that this admission doesn't meet the criteria for medical necessity. ** The empty suitcase logo Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. xref Claims Address. When a dependent is double-covered under married parents' health plans, the primary plan is the coverage of the parent with his/her birthday earlier in the year, regardless of their actual age. If you submit your claims electronically, you may receive electronic remittance for the following: Remittance is available online-just let us know. ACA BCBS of Alabama Thank you for choosing Regence as your health plan administrator. AEK Independence Blue Cross ADJ Anthem BCBS of Missouri . Anthem Blue-Cross Blue-Shield of Colorado. AGB Excellus BCBS To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. Your account number can be included in box 26 (Patient's Account Number) of the CMS-1500 form whether you submit electronically or on paper. CZU Anthem Blue Cross of California 0000005825 00000 n %%EOF Precertification remains the responsibility of the provider for all Empire HMO network members. AGC MO BCBS MO, POB 419169 , Kansas City , MO , 64141-6169 888-989-8842, AHP Empire Empire BC, POB 5020 , Middletown , NY , 10940 800-772-2875, AHU PPO MD BC MD, 10455 Mill Run Circle , Owings Mills , MD , 21117 877-228-7268, AHW PA BCBS NE PA, 70 N Main St , Wilkes-Barre , PA , 18711 717-829-8500, AIU PA Independence BC, 1901 Market St , Philadelphia , PA , 19103 215-564-2100, AKM MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237 Washington Contracted Providers: If we fail to satisfy either of the above standards, well pay interest on each claim that took longer than 60 days to process at a 12 percent annual rate (unclean days are not applied toward the 60 day calculation). Boise, ID 83707. Our Customer Care lines will re-open at 6 AM PT the following business day. A Level I Appeal is used to dispute one of our actions. AAN Anthem Blue Cross of California Interested in joining our provider network? If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. CWI Blue Shield of California An EDI representative will review the test claims with you or your vendor. We will notify you once your application has been approved or if additional information is needed. Examples of ID numbers: As a provider servicing out-of-area members, you may find the following tips helpful: ** Ask the member for the most current ID card at every visit. Your health care provider will require that you full and distribute these declare paperwork to UnitedHealthcare. If you have questions, please contact your local Blue Cross and Blue Shield company. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. Do not make up alpha prefixes or assume that the members ID number is the Social Security Number. QAB. ** PPOB in a suitcase logo, for PPO members with access to the BlueCard PPO Basic network There is no charge to healthcare providers who submit electronic claims directly to us. Our Provider Integrity Oversight Committee reviews proposals for new payment policies and updates to our policies. We forwarded this claim to the member's home plan for processing. the claims for which interest payments have been applied during that period. All the articles are getting from various resources. The plan doesn't cover cosmetic services. We abide by the following COB standards to determine which insurance plan pays first (primary carrier) and which pays second (secondary carrier). FAQs & Resources What type of EDI transactions does RGA accept? DCY BCBS of Florida ADW Carefirst BCBS Maryland 0000018992 00000 n CWN Carefirst BCBS Washington DC The Federal Employee Program (FEP) NO LONGER uses the address below, and mail will discontinue to be forwarded to the correct address above. CZV BCBS of Alabama Atlanta, GA 30348-5557. ** The alpha prefix is critical for the electronic routing of specific HIPAA transactions to the appropriate Blue Plan. Coronary Artery Disease. CZZ Highmark BCBS Claims UMP administered by Regence BlueShield (Medical only) (UMP Achieve 1, UMP Achieve 2, UMP High Deductible, UMP Plus) Online: Uniform Medical Plan for school employees. Doing so may cause delays in the handling of your inquiries and claims. Receiving payment 1-877-764-8724 Email Us. <<1CC62891B116FE488EB50D904D0BD9AE>]/Prev 176800/XRefStm 1570>> Postal Prescription Services Online: Your PPS account Phone: 1 (800) 552-6694 TRS: 711 Fax (for providers only): 1 (800) 723-9023